Project Summary The purpose of the renewal of this mid-career investigator award titled, ?Malnutrition, Diet and Racial Disparities in CKD (MADRAD)? by Kamyar Kalantar-Zadeh, MD, MPH, PhD, Professor of Medicine, Pediatrics and Public Health at the University California Irvine School of Medicine and UCLA School of Public Health, is to provide him with significant protected time to continue and expand his ongoing patient-oriented research endeavors with heightened focus on mentoring early-career investigators in several University of California and Veterans Affairs-affiliated campuses in Southern California. These centers provide care to underserved, indigent populations and minorities who suffer from CKD and who require dialysis for survival. In the US, African Americans and Hispanics have a substantially higher prevalence of end-stage renal disease (ESRD) (3.5 and 1.5 times higher, respectively) than non-Hispanic Whites. While the overall 5-year survival of ESRD patients is less than 40%, with the highest mortality risk observed among malnourished patients, minority dialysis patients exhibit lower mortality. Discovering the roots of CKD racial survival differences and the contribution of nutritional status and dietary factors to these disparities may have major clinical and public health implications. The PI hypothesizes that these disparities are due to distinct pathophysiologic mechanisms related to nutritional status and dietary intake across race/ethnicity. Several alternative hypotheses related to racial/ethnic differences in genetic polymorphisms, bone and mineral disorders, mental health and psychosocial factors, and dialysis treatment characteristics will also be examined. The PI proposes a 5-year prospective patient-oriented research study with repeated measures in a dynamic cohort of 1,500 hemodialysis (HD) patients (1/3 African American and 1/3 Hispanic), in collaboration with Southern California dialysis clinics. Nutritional status, dietary intake, psychosocial status, quality of life, clinical events, and survival will be longitudinally assessed. Genetic factors such as APOL1 risk alleles will also be examined, and biospecimens for future ancillary studies will be stored. In a substudy of 360 subjects, additional tests of body composition and dietary intake will be performed. Race/ethnicity specific risk-stratification scores will be developed and validated in a national retrospective cohort of over 150,000 HD patients. The support of the K24 award for this prospective study will allow PI to achieve the following goals: (1) Continue to expand his productive activities and capabilities as a mentor and facilitator for early-career investigators in renal nutrition and CKD disparities by leveraging his networking relationships across several campuses and centers including the University of California system and its Departments of Medicine and Pediatrics, Kaiser Permanente of Southern Calif., UCLA Public Health, and LA and Orange County Health Departments; (2) continue to expand his persistent efforts in increasing the participation of minority populations in CKD research studies across Southern California; and (3) continue his cultivation of an innovative area of CKD disparities and nutrition research through promising early career investigators and the ongoing support of collaborators in Southern California. The data and hypotheses generated during this 5-year cohort study will be utilized to promote additional patient-oriented studies by mentees under Dr. Kalantar to improve patient outcomes.